Managing Anxiety And Depression In Parkinsons Disease
A combination of medication and other therapies can help ease non-motor symptoms affecting those with Parkinsons disease.
Most people think of Parkinsons disease as marked only by tremors, muscular rigidity and slow, imprecise movements, but Parkinsons is more than a movement disorder.
Most people with Parkinsons also have quite a few non-motor symptoms, such as anxiety, depression and psychosis. Many of these symptoms may have started before the Parkinsons disease became obvious.
The effects are widespread. Several years ago, a large clinical study of more than 1,000 people with Parkinsons disease of various durations demonstrated that only 1.4 percent of the participants did not report any non-motor symptoms.In other words, 98.6 percent of the study participants had some form of NMS. Psychiatric symptoms accounted for 60 percent, while visual hallucinations that could have signified psychosis were present in about 35 percent of patients.
Thats why taking action is important. If you or a loved one has had a new diagnosis of Parkinsons disease, we recommend an immediate evaluation for depression, mood and cognitive problems. Frequent monitoring should also be done throughout the course of the disease.
Here are some of the common symptoms and treatment methods for Parkinsons patients with depression and dementia:
Psychological And Physiological Anxiety Measures
Repeated measures ANOVA indicated a significant effect on phase and group × phase interaction for VAMS anxiety factor . However, no difference was found between the groups . With regard to other VAMS factors, there was a significant effect of phase on mental sedation , physical sedation , and other feelings . However, there were no significant effects of these parameters on group × phase interaction and the groups.
Figure 1
Repeated measures ANOVA showed a significant effect of phase on heart rate without differences between the groups or group × phase interaction. Moreover, there were no differences in systolic or diastolic blood pressure between the phases, groups, or group × phase interaction.
How Are Mental Health Problems Treated In Parkinsons Disease
Mental health problems in Parkinson’s disease can be treated with a combination of medication, talking therapy and lifestyle changes. Your doctor may also suggest joining a Parkinsons support group so that you can share your challenges with other PD patients.
Other ways to care for your mental health if you have Parkinson’s include:
Parkinson’s disease and mental health problems are not easily cured. However, there are a variety of treatment options and lifestyle changes that can boost your mental wellbeing and improve your overall quality of life.
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Anxiety As An Early Warning Sign
It may be that anxiety disorders that are diagnosed as much as two decades before Parkinsons disease may be a harbinger of the disease, says Gregory Pontone, M.D., director of the Johns Hopkins Movement Disorders Psychiatry Clinic. Parkinsons disease, like Alzheimers disease, has what experts call a long approach, he says, and anxiety may be part of that long approach.
One theory is that the anxiety that comes before Parkinsons results from the same underlying changes in brain chemistry and circuitry. Others believe that Parkinsons disease and anxiety share a common genetic risk factor. Either way, taking a closer look at the link can help doctors understand the causes of Parkinsons and treat patients with the disease.
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Q: Once I Am Vaccinated Can I Go Back To Doing Things As I Was Doing Them Before The Pandemic
A: The CDC continually updates its guidelines in response to evolving public health conditions.
- Fully vaccinated people can participate in many of the activities that they did before the pandemic for some of these activities, they may choose to wear a mask.
- To reduce the risk of becoming infected with any variant of COVID-19 and potentially spreading it to others, everyone, including those who are fully vaccinated, should wear a mask in public indoor settings if they are in an area of substantial or high transmission. The CDC constantly updates the map of US counties for which this applies. You will need to refer to your local public health authorities to determine whether your area is one with substantial or high transmission
- Fully vaccinated people might choose to mask regardless of the level of transmission in their area, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated. People who are at increased risk for severe disease include older adults and those who have certain medical conditions, such as diabetes, overweight or obesity, and heart conditions.
Q: How Does The Delta Or The Omicron Variant Affect Someone With Pd
A: We do not have any specific data yet on how the various variants affect people with PD.
The COVID-19 virus, like all viruses, is able to mutate and create variants of itself. Many variants of COVID-19 have been identified around the world. Only a few of these variants have been of concern to public health however, because they have a characteristic that makes the virus either more easily transmissible or more likely to cause significant disease. The Omicron variant is currently the variant of concern and further study is underway to determine its unique characteristics.
So far, the vaccines approved in the US do appear to offer protection against the Delta and Omicron variants, but likely not to the extent that was seen in the original trials. That means that fully vaccinated people are more likely to get infected with the variants of COVID-19 than the original strain. However, the major goal of the vaccines is to prevent severe illness, hospitalization, and death from COVID-19 and all the approved vaccines are approximately 80-90% effective in preventing these consequences of infection. Therefore, vaccination remains extremely valuable.
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Research Is Underway To Further Understand The Cardiac Effects Of Parkinsons
It is possible to image the sympathetic nervous system of the human heart by injecting a radioactive tracer, meta-iodo-benzyl-guanidine, . Development of this technique, known as MIBG cardiac imaging, holds much promise as a test to confirm the diagnosis of PD , to identify those who are at risk of developing PD in the future, and to distinguish PD from related disorders. MIBG cardiac imaging is still considered an experimental procedure for detection of PD and is not yet in use as a clinical tool for this purpose.
A recent research study was conducted in monkeys in which the destruction of the sympathetic nerves of the heart was chemically induced to mimic the changes that are seen in PD. The cardiac system was then imaged using a number of new-generation radioactive tracers, which bind to markers of inflammation and oxidative stress. This model system may help to shed light on the molecular changes that accompany the loss of the sympathetic nerves of the heart and can also be used to track the response of the cardiac system to therapeutic agents.
Environmental Toxins And Parkinsons Disease
Neuronal cell death in PD may also be triggered by exposure to toxic substances or environmental factors which precipitate the symptoms of the disease as they render the brain vulnerable to subsequent physiological chronic stress . The environmental cause of PD mainly refers to exposure to dopaminergic toxins 6-hydroxydopamine , 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine , paraquat and rotenone as these toxins are known to induce formation of reactive oxygen species and oxidative stress which may result in neuronal cell death .
DA is one of the common neurotransmitters present in most parts of the central nervous system . The mesocortical, mesolimbic, nigrostriatal and tubero-infundibular pathways are the four main pathways that play a key role in dopaminergic signaling . DA cannot cross the blood brain barrier, therefore, it is synthesized from tyrosine which is carried into the brain via amino acid transporters . At the dopaminergic neuron level, tyrosine is then converted into dihydroxyphenylalanine by tyrosine hydroxylase then finally into DA by aromatic L-amino acid decarboxylase . DA is then stored in the vesicle until an action potential allows the vesicle to be discharged into the synapse . Monoamine oxidase is the enzyme that is responsible for breaking down excess DA and is known to similarly act on 6-OHDA inducing oxidative stress resulting in apoptosis .
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The Case Of Fluvoxamine Maleate
The role of serotonergic drugs in PD associated with depression has been receiving considerable attention amongst the research community . As a link between DA and the development of depression in patients with PD has been suggested, the pathophysiological features of both PD and depression have in common DA pathway dysfunction and depletion and/or 5-HT deficit . It has been suggested that an increase in serotonergic tone may indirectly influence DA function and may contribute to increased motor activity which is partially blocked by DA antagonists . Studies have shown that depression may be associated with an abnormal level of DA . As studies have also shown that brain regions affected by abnormal DA processing may also be affected when 5-HT is abnormally processed, we hypothesize that Fluvoxamine maleate treatment may play a role in improving the chemical imbalance caused by low levels of DA in the brain .
Q: My Husband Has Pd With Moderate Symptoms Normally He Is Independent With All His Activities Although He Walks Slowly One Day His Symptoms Worsened Dramatically And He Was Not Able To Walk I Took Him To The Er Where He Tested Positive For Covid
A: In general, people with PD and other brain illnesses often have 1) worsening of their PD symptoms in the face of inter-current illnesses such as COVID-19, and 2) have a slower recovery to their baseline once they have recovered from the inter-current illness. It sounds like both of these have happened to your husband. However, with proper rehab and some perseverance, there is hope that he will slowly return to his baseline.
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Stress And Mindfulness In Parkinson’s Disease: Clinical Effects And Potential Underlying Mechanisms
Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, the Netherlands
Donders Institute for Brain, Cognition, and Behavior, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, the Netherlands
Correspondence to: Ms. Anouk van der Heide, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB Nijmegen, the Netherlands E-mail:
Anne E.M. Speckens MD, PhD
Radboud University Medical Centre, Department of Psychiatry, Centre for Mindfulness, Nijmegen, the Netherlands
Tessa F. Peerbolte BSc
Donders Institute for Brain, Cognition, and Behavior, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, the Netherlands
Bastiaan R. Bloem MD, PhD
Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, the Netherlands
Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, the Netherlands
Donders Institute for Brain, Cognition, and Behavior, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, the Netherlands
Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Radboud University Medical Centre, Nijmegen, the Netherlands
Donders Institute for Brain, Cognition, and Behavior, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, the Netherlands
How Does Parkinson Affect The Nervous System
What Is Parkinsons?Parkinsons Effect On The Nervous System And Dopamine.The Two Types Of Parkinsons Related To The Nervous Systemdistinct subtypesAutonomic Nervous System And Parkinsons
How To Keep Your Nervous System Healthy?Here are some important recommendations:
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Recommendations For Future Studies
Future trials should be adequately powered to demonstrate a clinically meaningful difference between a mindfulness and control intervention . The optimal control intervention should have a similar duration and amount of personal contact as mindfulness and should not differ in degree of physical exercise. When investigating the effect of mindfulness on disease progression, it is possible that interventions longer than 8âweeks are needed . Promising outcome measures include anxiety and depression , and it might be considered to test the merits of mindfulness in a sample of patients with PD scoring high on these symptoms. It would also be informative to assess effects on other nonmotor symptoms, such as pain, sleeping problems, and digestive issues. Any effects on motor symptoms are currently less clear, and these may be better investigated using wearable devices to identify even subtle improvements or using functional outcome measures. Specifically, such functional measures could include brain imaging , activity of the HPA axis , or inflammatory markers , and these may help to better understand the underlying working mechanisms. Follow-up should ideally be 6âmonths or longer, because the effects of a mindfulness-based intervention may consolidate with longer follow-up.
Serotonin Hypothesis Of Depression
Serotonin is mainly produced in the dorsal raphe nucleus . Serotonin transporters take up released serotonin from the synaptic cleft into serotonergic neurons in a manner that helps to modulate various functions in the brain including mood and emotion . The striatum, the amygdala, and the prefrontal cortex are regions of the brain that are innervated by serotonergic neurons . These brain regions including the dorsal raphe nucleus which is part of the brains serotonergic system, are activated during early maternal stress . Abnormal 5-HT levels in these brain areas have been associated with depression . Pre-clinical and clinical studies have demonstrated that early life stress affects 5-HT levels in the brain and this may lead to depression . Selective serotonin re-uptake inhibitors are a class of antidepressant drugs commonly used to treat depression . SSRIs work by blocking 5-HT re-uptake thus increasing the availability of 5-HT in the synaptic cleft as well as its chance to bind to receptors in the post-synaptic membrane . Therefore, by restoring the levels of monoamines and their transporters in the brain, SSRIs drugs are appropriate treatments to address early life stress dysfunction that predisposes to depression later in life.
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Anxiety And Parkinsons Research
What does this finding mean for the future of diagnosis or treatment of Parkinsons? Ongoing research is compelling, says Pontone. Part of what we are doing is looking at anxiety disorders that occur long before the onset of Parkinsons to see if there are characteristics that may differentiate that anxiety or predict an increased risk of Parkinsons disease.
Meanwhile, because theres an established link between anxiety and Parkinsons disease, patients and their families should be upfront with their doctors about anxiety symptoms. Behavioral therapy and medications for example, anti-anxiety meds or antidepressants can effectively treat anxiety disorders. Theres no need for anyone to suffer in silence.
Targeting Parkinsons-Linked Protein Could Neutralize 2 of the Diseases Causes
Researchers report they have discovered how two problem proteins known to cause Parkinsons disease are chemically linked, suggesting that someday, both could be neutralized by a single drug designed to target the link.
Q: What Happens If I Get A Cough From Covid
A: You are correct that it is important to pay attention to possible medication interactions. Cough and cold medications containing dextromethorphan, pseudoephedrine, phenylephrine, and ephedrine need to be avoided only if you are on a monoamine oxidase inhibitor such as rasagiline, selegiline or safinamide. Be sure to check the product ingredients before purchasing, and if you are unsure ask your doctor or pharmacist to clarify which brands/medications should be avoided. If you are on an MAOI, any other cold medication without these ingredients is safe for you to take. If you are not taking an MAOI, any cold medication is suitable for you.
Here is the list of medications to avoid in PD.
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A Combined Depression/pd Animal Model
In our own studies, we have developed an animal paradigm that combines the striatal 6-OHDA lesion model of PD with the CVS-induced model of depression. With this model we are able to examine the combined effects that chronic stress and relatively progressive dopaminergic neuron loss can have on motor symptoms and nigral cell degeneration. We have observed that CVS worsens motor symptoms and increases neurodegeneration of dopaminergic neurons in the SNpc . However, it appears that the stressors needs to be administered concomitant with the neurotoxin lesion in order to do so, as administering the stressors only prior to or only following the lesion did not affect motor symptoms. The stress dysfunction occurring prior to the onset of motor symptoms and continuing after neuronal loss ultimately causes a worsening of the PD symptoms and accelerates nigral dopaminergic cell degeneration. Potential mechanisms underlying this CVS-induced exacerbation of experimental parkinsonism are currently being investigated.
Q: What Side Effects Can I Expect From The Covid
A: While there have been some varied reactions, the COVID-19 vaccines are approved by the FDA and considered safe. Some people may simply experience a mildly sore arm and that is it . There are some who may have a more noticeable reaction and feel chills, body aches, headaches and/or fatigue for 1-2 days, but these generally clear up quickly. There have also been some anecdotal reports of PD symptoms temporarily worsening after COVID-19 vaccination.
Weighing the risks of someone with PD getting COVID-19, as well as the significant downsides of all the pandemic-related restrictions on social and physical activities to someone with PD vs. the potential for side effects from the vaccine, I would favor getting the vaccine. As always, discuss all your medical concerns with your neurologist and primary care physician.
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